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Hurricane Irene Highlights Life-Saving Potential of Mobile EMRs

Watching the East Coast prepare for Hurricane Irene last weekend had me flashing back to the aftermath of the tornadoes that hit Joplin, Missouri, earlier this year. Would hospitals suffer the same levels of destruction that St. John’s Regional Medical Center did? Would they be as successful in evacuating patients and treating them off-site with limited supplies and infrastructure?

Fortunately, lessons learned from providers in Joplin, and to a greater extent from the devastation of Hurricane Katrina in 2005, enabled providers along the East Coast to implement well thought-out disaster preparedness plans at their facilities. Mother Nature also lent a hand by withholding from Hurricane Irene the extreme conditions her predecessor unleashed on the South some six years ago.

The team at North Shore – Long Island Jewish Health System makes a compelling case study for the smoothness with which detailed planning can bring to hospital evacuation scenarios. The short video below gives a glimpse into the efforts the hospital’s staff put forth to evacuate 252 in-patients and 50 emergency department patients in less than 24 hours. The helpful Mr. HISTalk has compiled a brief list of updates on several additional hospitals affected by the storm (scroll down to the bottom of the post for updates).

It was by pure coincidence that news of e-MDs’ launch of its Rounds® mobile EMR app for the iPhone reached my desk just as Hurricane Irene was closing in on land. The new app enables physicians to remotely and securely key in patient information from their EHRs via their mobile device – surely a tool that physicians would find useful in treating patients during an evacuation process such as that undertaken by North Shore-LIJ.

Patrick Hall, Executive Vice President of Business Development at e-MDs, told me that the mobile health solution was launched “to help our physician clients stay connected to patient information. We have observed that [they] have been dealing with more and more work when they are away from the office. This provides them with a convenient tool to deal with some of this, using an easily carried device that gives them access to complete patient information so they can make informed decisions about patient care.”

I’ll be interested to learn if any hospitals or private practice physicians came away with “success” stories because of their mobile EMR solutions. I think we can all breathe a sigh of relief that successes this time around far outnumber the failures.

August 31, 2011 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 51-55

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

55 Discover how easy it is to interface to the EMR.
One good indication of how easy an EMR system is to interface is to look at how many companies they interface with. Another is to talk with other users of that EMR that have had to have an interface created with said EMR. As I mentioned in a recent comment response, just because they say they “can” or “could” do an interface doesn’t mean that they actually will. Add interface requirements in your contract if they’re needed. Be sure to include the expenses related to the interface in there as well.

54. Make sure to understand the licensing model
There are a lot of ways for an EHR vendor to make you pay. So, be sure you’re aware of all the expenses related to buying and implementing an EHR. Instead of recounting all the possible EHR costs here, I’m just going to link you to my pretty comprehensive list of unexpected EHR costs. Going through that list will help make sure you know what you’re getting into cost wise. You can be sure the EHR salesperson won’t be giving you this list.

53. Does your product handle billing?
Many people love the integrated billing in an EHR. Some can get away without it, but most people I know prefer some billing component as part of the EHR.

52. How is licensing managed?
While related to #54, I see this EHR tip as understanding when and how they’ll charge for licenses. Do you have to buy a whole group of licenses which you may or may not use or can you add licenses later as you grow your practice? As Shawn suggests in this tip, it’s best if you can do “just in time licensing.”

51. Make certain you know what upgrades for license expansions cost
Understand the costs related to expanding into a new line of service. Do you have all the modules you need? What’s the cost to add new modules? Will your server support that new module?

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

August 30, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Valuable Healthcare Data or TMI? The Quantified Self

Maybe two years ago, I saw this interview on TV with this Silicon Valley yuppie who had a camera attached to a cap on his head (or maybe it was a backpack. I digress.) Every 10 seconds, the camera would kick into action and take a snapshot. This way, the yuppie surmised, he would have a repository of pretty much everything he had ever done, even the parts he didn’t like or want to share.

Fascinating as the interview was, to me the $64,000 question was Why? Why, I wondered, would someone want this much detail about his life?

Turns out, there are a whole lot of people who are into this kind of minutiae logging. And they may very well be changing the way medical records are used and stored. At Quantified Self, people believe that self-logged data holds the key to a better understanding of oneself. And some Quantified Selfers are on a mission to make it easier and cheaper to save one’s personal data.

I can think of a myriad things about my health that I might want to log and analyze – blood pressure, weight, mood swings, food intake and (ew! even) bowel movements. Such data might serve to show me the cause and effect, or at least correlations, between my daily choices and the end result of these choices. Such feedback loops apparently work. Last month’s Wired story on this topic shows how innocuous and ineffective seeming reporting can be used for positive behavior change. (There’s an interesting section on how one inventor helps non-compliant patients take their pills as directed.)

This is still a newish area of experimentation. We still don’t know if, and when, and how this trend will play out in the healthcare field. To me, there are several questions that need to be answered:

  • How is data going to be stored and transmitted to the EMR?
  • Who takes charge of interpreting all this data we will gather? Will my already overworked primary care physician for example want to look through graphs of my self-reported B.P. and weight changes?
  • How will this data interface with EMR systems already in place?
  • How safe is it to maintain a personal health data journal? What are the HIPAA implications?
  • How much is too much?

It will be interesting to see how this form of health-logging will play out.

August 29, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Semantic Interoperability and the Replacing Doctors with Technology

In one of my many conversations with people about EMR and healthcare IT I sent the following response to comments about Semantic Interoperability in healthcare.

I agree with you that we’re a long way from semantic interoperability. Plus, we won’t every reach the full vision of what we’d like it to be.

With that said, we will make major progress on understanding the data and assisting the doctors in what they do. It will never replace the doctors, but will be an aid to them to do better work. Other inventions on the other hand could replace doctors to some extent. Similar to how the thermometer in every home has replaced a number of doctor’s visits.

I make some pretty wide assertions in the comment above. I figured, why do them in private, when it’s so much more fun to do it in public where others can discuss and we can all learn. What do you think? How far are we from semantic interoperability in healthcare?

What about technology as a replacement for doctors? Do you think that will ever happen? Will semantic interoperability help that to happen?

What are the future “thermometers” in healthcare which will change our interaction with our healthcare providers?

August 26, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Guest Post: ONC-ATCB ICSA Labs – The Future of EHR Testing Requires Security and Privacy Enhancements

Guest Post – Amit Trivedi – As the healthcare program manager for ICSA Labs, Amit Trivedi spearheads the lab’s overall efforts in the healthcare industry, including launching and managing the 2011/2012 Office of the National Coordinator (ONC) Authorized Testing and Certification Body (ATCB) certification program.


We all know there is no such thing as perfect security. All we can do is try to mitigate as many risks as possible. In this regard, there are areas related to information security that the current ONC-ATCB 2011/2012 (commonly referred to as meaningful use) certification testing does not yet address and that the health IT community should be aware of when implementing systems.

ICSA Labs is an Office of the National Coordinator-Authorized Testing and Certification Body (ONC-ATCB), designated to test both complete and modular electronic health record (EHR) technologies under the auspices of the federal government’s Temporary Certification Program. ICSA Labs has a history rich in the certification of security products. We have been testing security products and developing test criteria for more than two decades and we understand the importance of raising security awareness in the health IT community and helping Eligible Providers and Hospitals understand what meaningful use EHR certification testing does and doesn’t cover.

It is important to remember that regardless of the number of security features a product has, an incorrect or incomplete implementation can introduce vulnerabilities or compromise the security of the system. Certification testing can really only demonstrate that a product is capable of being used securely, not that its security can never be compromised.

Testing bodies must test products within the scope of approved test procedures. As an organization that has developed testing procedures and methodologies, we understand that there is a delicate balancing act when developing requirements so that general concepts and capabilities are covered by the testing, but the testing process is not designed so specifically as to stifle innovation in new products. As such, we recommend that end users and implementers be aware of these requirements when deploying ONC-ATCB 2011/2012 certified products.

Encryption Requirements Do Not Address the “What”

Consider the encryption requirements (criteria 170.302.u and 170.302.v). The current testing criteria require FIPS 140-2 level encryption. This an excellent way to require products to support some of the best levels of encryption available today, and that they are also in line with other federal encryption requirements.

One could compare encryption to a bank vault. You might purchase the most secure, unbreakable vault in the world, but if you don’t put your valuables in the vault, it won’t be of any help when there is a break-in. The current meaningful use testing procedures do not dictate what must be encrypted. Ultimately it falls to end users to make a determination as to how they want to implement security – hopefully basing the decision on a risk-based approach. Fortunately, meaningful use testing and certification follows a staged approach to getting from where we are today to where we’d like to be in the future. The meaningful use certification is planned to be rolled out in three stages. Right now, we are in the midst of Stage 1. Some recommendations to the ONC for Stage 2 security criteria include addressing things like encrypting data at rest (including data in datacenters and mobile devices) – something that is not part of the Stage 1 requirements.

Negative Testing Examines the Unexpected

Another area to highlight is related to negative testing, which is currently out of scope for ONC-ATCBs. The testing performed today relies on giving the EHR an expected input and verifying that the expected result is met. Negative testing, however, is the concept of giving unexpected or invalid inputs to a system and verifying receipt of an expected result (typically, that the data is not accepted or an error is generated that does not crash the system). Negative testing is common throughout ICSA Labs’ proprietary security testing programs and something we feel should be incorporated into future testing of EHR technologies under the ONC Certification program.

Consider the authentication and access control requirements (criteria 170.302.t and 170.302.o). Some of you may be aware of an old Unix bug that resulted in the operating system being unable to correctly support passwords over eight characters. If the password was 12 characters long, a user only needed to enter the first 8 characters to be allowed to login. This made password cracking on Unix servers much easier, and because the system allowed the entry of a longer password, most users were unaware of this limitation.

ICSA Labs has discovered the same or similar problems when testing products in our proprietary security certification programs, and the primary way we discover this is by negative testing. For example, we configure a password greater than eight characters, and then we attempt to login to the system using only the first eight characters. This should be treated as invalid by the system and rejected. However, the meaningful use EHR testing only tests that the system accepts valid passwords. There is no testing done on the system’s acceptance or rejection of invalid passwords.

The Future of EHR Testing Must Increase Security, Privacy

As we progress to the next stages of meaningful use certification, the requirements should begin to look at other areas of security, such as application testing for vulnerabilities like buffer overflows, SQL Injection, and cross-site scripting attacks. These are all examples of security testing best practices. In many instances, ONC has signaled its flexibility in allowing third-party products to complement functionality of EHR technologies, which means that not all of the functionality needs to be native to the product. This can allow EHR developers to focus on functionality that their customers are looking for, while at the same time keeping security as an important consideration in the product life cycle development.

It is our hope that future stages of meaningful use testing will raise the bar and specify how and when features like encryption should be used and the scope of testing will be expanded to include things like negative testing. As the meaningful use criteria evolve, it is critical that both the criteria and testing procedures are developed in ways that consider the long-term security and privacy of patient health records.  

August 25, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Neil Versel on Meaningful Health IT News

I’ve been really intrigued by a number of the articles written by the famous healthcare IT journalist, Neil Versel on his site Meaningful Health IT News (Note: I host his blog, but he creates all the content). Here’s a few of his interesting posts and my thoughts about them.

Founder of Twitter, Biz Stone to Speak at HIMSS 2012 – I think this is really exciting. I’m interested to hear what he’ll say about healthcare. I’m not sure how much he’ll mention Twitter, but he’s got a smart mind and I love listening to smart people.

I’d love for Biz to take questions from Twitter during the event too. He also helped create and launch blogger. Maybe we could convince Biz Stone to come to the 3rd Annual New Media Meetup at HIMSS 2012.

BTW, @HIMSS got Biz Stone’s Twitter handle wrong. He’s @Biz.

CPOE Cartoons – Everyone needs a good laugh. So, I enjoyed these cartoons which make light of the idea that doctors might just search Google for the answers. Of course they won’t, but that doesn’t change the fact that doctors of the future will have amazing resources online to help them treat patients better than they do now.

Neil also mentioned the passing of Bernadine Healy and Janice Simmons. My condolences go out to both their families. Janice did something similar at FierceEMR to what I do on here. It’s a stark reminder that life is short. I’ve had it on my mind lately since last week my wife and I created a Trust and last night I finally put together the information about all my websites for my wife should something happen to me. Here’s hoping that she never needs that information, but I feel much better knowing she has it.

August 24, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

EMR Subtleties Are Hard to Quantify

How would you respond if someone asks you, what makes a great EMR?

There are plenty of answers that come to mind. However, at a recent conference I attended, I was struck by a simple description a doctor made about a feature he liked in his EMR.

He described how a new patient portal they implemented would ask the patient a bunch of important questions. Then, the output to the doctor would display a list of those questions and responses. However, he loved how the so called “incorrect” answers were in a different color.

I’m sure many of you might be thinking, well isn’t that an obvious feature? Some of you might also be thinking, is John really trying to tell me that this feature is what makes that EMR great? The answer is Yes on both accounts. Although with one caveat.

First, it’s an obvious feature, but there are hundreds and possibly thousands of obvious features that EMR companies haven’t had the time or the foresight to put into their EHR package. Maybe they were working on a legacy EHR where such an obvious feature was difficult to implement, so they put it off. Maybe they were trying to get the software release out the door and so they didn’t take the time to add such an obvious feature. Maybe they just haven’t had “the time” to add it. The point being that there are many “obvious” features that never make it off the development list.

Second, these subtle features are what makes an EMR great. No, not one subtle feature. I’m talking about hundreds of subtle features that are done throughout the entire EMR system. The compilation of many subtle features creates a beautiful symphony of EMR greatness.

How then do you measure hundreds of small but great features in an EMR?

August 23, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 56-60

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

60. Reporting, reporting, reporting, reports
What’s the point in collecting the data if you can’t report on it? I’ve before about the types of EMR reports that you can get out of the EMR system. The reports a hospital require will be much more robust than an ambulatory practice. In fact, outside of the basic reports (A/R, Appointments, etc), most ambulatory practices that I know don’t run very many reports. I’d say it’s haphazard report running at best.

Although, I won’t be surprised if the need to report data from your EHR increases over the next couple years. Between the meaningful use reporting requirements and the movement towards ACO’s, you can be sure that being able to have a robust reporting system built into your EHR will become a necessity.

59. Are the meaningful use (MU) guidelines covered by your product?
Assuming you want to show meaningful use, make sure your EHR vendor is certified by an ONC-ATCB. Next, talk to some of their existing users that have attested to meaningful use stage 1. Third, ask them about their approach for handling meaningful use stage 2 and 3. Fourth, evaluate how they’ve implemented some of the meaningful use requirements so you get an idea of how much extra work you’ll have to do beyond your regular documenting to meet meaningful use.

58. It they aren’t CCHIT certified take a really really hard look
Well, it looks like this tip was written pre-ONC-ATCB certifying bodies. Of course, readers of this site and its sister site, EMR and HIPAA, will be aware that CCHIT Has Become Irrelevant. Now it’s worth taking a hard look if the EHR isn’t an ONC-ATCB certified EHR. There are a few cases where it might be ok, but they better have a great reason not to be certified. Not because the EHR certification provides you any more value other than the EHR vendor will likely need that EHR certification to stay relevant in the current EHR market.

57. What billing systems do you interface with?
These days it seems in vogue to have an integrated EMR and PMS (billing system). Either way, it’s really important to evaluate how your EMR is going to integrate with your billing. Plus, there can be tremendous benefits to the tight integration if done right.

56. How much do changes and customizations cost?
In many cases, you can see and plan for the customization that you’ll need as part of the EHR implementation. However, there are also going to be plenty of unexpected customizations that you don’t know about until you’re actually using your EHR (Check out this recent post on Unexpected EHR Expenses). Be sure to have the pricing for such customizations specified in the contract. Plus, as much as possible try to understand how open they are to doing customizations for their customers.

Check out my analysis of all 101 EMR and EHR tips.

August 22, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Top EMR Vendors – Solo Physician Practice – Black Book Rankings

I’m always interested in ways to try and differentiate the various EMR and EHR vendors. I’m completely sympathetic with doctors who are sorting through the 300+ EMR Companies in the marketplace. Most doctors I know, don’t want to become software selection experts or at least don’t want to spend their free time doing it.

However, it’s amazing the various services out there that try and capitalize on this need that doctors have to narrow down the field of EHR vendors. I think that’s basically what the Black Book EMR Rankings (listed on Amazon even) are basically doing with their EHR rankings. Yes, I know Black Book’s been around for a while, but I just saw it again and had to post.

They try and say that they sent the survey out to 70,000 “physician leaders and non-clinical administrators of publicly traded hospital corporations, private hospitals, academic medical institutions, multispecialty medical group practices, small and multiple physician practices, hospitalist groups, emergency departments, institutional members and officers of various healthcare/medical and IT professional organizations, subscribers of our media partners and previously validated survey participants.”

The problem is that they only received “4502 validated respondents ranked 174 EMR suppliers.”[emphasis mine] I’m not a statistics guru, but I wouldn’t be putting my EMR selection on an average of 25 responses per EMR. Plus, for many EMR it was likely much lower than 25. Not to mention, they only had responses from 174 companies. What about the other 126+ EHR vendors that had 0 responses?

Plus, the Black Book breaks it down even further by size of practice. They have 6 categories in just the ambulatory side. That’s an average of just over 4 responses per EHR vendor per category size. Although, it’s less since they have a bunch of acute care categories as well.

When you look at the list, I see a lot of the major EHR companies and a bunch of companies I’ve never heard of before. Not to mention there are a lot of big time EHR players from companies that Black Book probably has never heard about that aren’t on the list.

Unfortunately, there’s no real quality source to differentiate the various EHR companies. If there was I’d shout it from the rooftops (or at least my blog). Until then, the only solution is the work of reviewing your needs and evaluating the various EHR software yourself.

Since I’m sure many will wonder what EHR vendors made the Black Book list, here’s the list of Top Ambulatory EHR companies by practice size after the break: Read more..

August 19, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

One Former Practice Fusion Consultant’s Issues and Practice Fusion’s Response

As most of you know, I don’t often point out individual vendors all that much. However, on occasion I get something sent to me that I think could add to the conversation around various EHR software. I got one of those emails from long time reader, Carl Bergman. He chose to no longer be a Practice Fusion consultant and wanted to share the issues he had with the current Practice Fusion EHR product.

I haven’t had the time lately to be able to dig into Carl’s comments myself, so that I could make an assessment of his comments about the Practice Fusion EHR. However, in the interest of sharing both sides of the story I asked Practice Fusion to comment on Carl’s thoughts on their EHR software. So, below you’ll find Carl and Practice Fusions comments.

As with most things in life, take everything you read in this post with a grain of salt and evaluate what each side says for yourself. Either way, I think it could start a helpful discussion for those considering the Practice Fusion EHR.

Letter sent from Carl Bergman to Practice Fusion:

I have been a certified Practice Fusion Consultant for several months. I’m writing to ask that you remove me as a PF consultant.

I have given this decision a great deal of thought, but I do not believe that I can market PF in good conscious. This is not due in any way to how I have been treated, nor is it any reflection on the support that PF offers to its consultants, which is considerable.

Rather, it is based on what I believe are important, missing product features. This lack of features makes it impossible for me to recommend PF to any of the leads that you have generously shared with me. (Please note, I have not and will not approach any of those leads due to your referral.)

I was initially attracted to PF due to its web basis, ease of use and, simple set up and good support. However, as I went through PF I saw that it was lacking in four important areas: Workflow, Billing, Security and Reporting.

Workflow. Each patient in a medical practice presents a different set of circumstances, attributes and issues. These require that the practice be able to respond in a concerted and orchestrated way. PF lacks this ability. Specifically:

Appointment Type. PF has six fixed appointment types, New, Recurring, etc. They may not be changed, deactivated or added to. Appointment duration is set separately for each appointment. An appointment’s specifics are kept in a note.

Appointments are key to a practice’s workflow. For example, PF has a wellness appointment type. However, there is no ability to link the appointment type to look for outstanding labs before the appointment is set. Nor can appointment type reserve a room or assign a tech to take vitals, etc., as part of an exam. As a result, a practice is left to its own, non traceable, ad hoc methods for preparing for and carrying out the exam.

Shared Task List. When a practitioners decides on a course of treatment, this can set a number of things in motion:
• Labs
• Rx
• Recurring Appointments
• Procedures
• Referrals
• Billing

Each of these also is an assignment to someone else to carry out a portion of the plan. While PF has lists for a patient and individual task lists for each person, it does not have an overall view of pending tasks so a manager can see bottlenecks or assign workloads.

Security. PF has four fixed levels of security: Staff, Nurse, NP/PA and PA. Users are assigned to one or more of these levels and optionally as administrators. As with appointment types, the categories may not have their attributes modified or may new ones be added.
I found a definition of the categories in the Support Forum/Getting Started, which defines different user’s edit rights. It is silent about how, if at all, access is limited. Apparently, any user may view all parts of a record. Allowing any user to view anything in an EMR is a dangerous policy because it allows confidential information, such as an AIDS test result, to be known by those who have no need to know it.
Billing. PF includes elements, such as insurance plans, copays, etc., that are usually associated with practice management and billing systems, so it is surprising that it does not include billing as well. Instead, it integrates with third party billing systems, such as Karo.

I have long been biased against systems that tie an EMR from one vendor with billing from another. No matter how well designed, the attempt to integrate two different data structures just doesn’t work well. While PF states that is it fully integrated with Karo, an on line subscription based billing system, but neither site has much detail on the integration much less a data model. I think a user should also know what, if any, terms, relationship, contract, etc., exist between PF and Karo or other billing services.

Aside from detracting from the free nature of PF, the question of the degree of integration is major. For example, who is responsible for the interface’s operation PF or Karo?

Is a demographic change in either reflected in the other? From what I read in the PF Community Forum, the answer is no. I would like to know whose reporting module, if either, can access the combined data from the two systems?

Also, if I use Karo, does that mean I have to set up a separate security system. To look at billing do I have to go from PF and log into Karo?

Reporting. A major advantage of an EMR over a manual system is not only the ability to find and retrieve a specific record, but also the ability to find and report on a selected set as well. For example, if the FDA notifies physicians that they should review all cases of Crone’s disease that are more than three years old who are on a specific dose of a particular antibiotic, PF could not do this.

PF’s reports are limited to searching and reporting on specific topics. In this, it compares unfavorably to a host of other EMRs on the market. If it did have a well developed reporting function, it could make up for some of its lack of workflow abilities, but it does not. This lack of reporting ability when combined with the lack of an internal billing function is a deal killer.

I regard each of the issues that I’ve listed to be a major problem any one of which would cause me to be skeptical of a product. Taken as a whole, and I am aware of the wide adoption of PF, I find that I cannot recommend PF as an EMR.

Carl Bergman
President
SilverSoft, Inc.

And Practice Fusion’s response:

Here’s some notes back. In general, Carl doesn’t seem to have a very deep understanding of the product. A failure on our part, perhaps, but these answers are easily given from our support team:

- Appointment type: EHR accounts come with six default appointment types, but any Admin level user is free to create their own to match their workflow. This setting is under the “admin” tab in the EHR.

- Task list: Each practice manages the passing back and forth of tasks a little bit differently. Most use the secure message feature to send follow-up, billing, lab messages, etc. A practice manager could review these messages or, more easily, could use the Live Activity Feed to see where there are bottlenecks. Since most of our practices are small (under 10 doctors) this doesn’t seem to be a big issue.

- Security: Each user has just one level of permission inside the EHR. Their individual login dictates the level of access they have. It is certainly not true than any user has the same access rights to any record. Plus, our activity feed gives an added level of transparency where you can see exactly who has accessed what, any actions they’ve taken, etc. That’s a unique Practice Fusion feature. However, it is a great suggestion to add more customization to these edit levels, that’s a popular request from our users as well and we have it on our development roadmap.

- Billing: We have the opposite bias from Carl here. We believe that being billing agnostic gives Practice Fusion users a great deal more flexibility in how they choose to manage their billing and an easier transition to EHR since they don’t have to change their billing process at the same time. Kareo is just one option that we provide our users, they are free to use whichever biller then would like. Their low-cost, integrated billing software is popular with our users. The integration today is fairly light, but we are working on ways to make it a more robust connection.

- Reporting: Practice Fusion does have some basic reporting features built in to the EHR today. For example, the reporting feature has assisted doctors with managing the Darvocet recall and with identifying H1N1 high-risk patients. The Crohn’s (note the spelling) disease example he gives would actually be fairly easy to run within PF. You would just do a report on ICD-9 code 555.9 with the date range set and then filter the resulting patients based on prescription (or run a second Rx report and merge). I don’t have any Crohn’s patients in my test account, so I ran a report on chronic migraine instead, below. However, we are in the process of upgrading the reporting feature for both Meaningful Use and our own planned enhancements.

There you have it. I’ll let you be the judge for yourself. Plus, I’m interested to hear what other Practice Fusion users have to say about the various opinions stated in this post. One thing that Practice Fusion has going for them is they at least don’t charge anything for their EHR. So, it’s not like a doctor using it can complain that they didn’t get what they paid for.

I have a feeling that this conversation will continue in the comments. See you there.

Full Disclosure: Practice Fusion is an advertiser on EMR and EHR. Although, I’d provide the same opportunity to any EHR vendor that would like to respond to comments I get about them.

August 18, 2011 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.